The regime's attempt to reform Thailand's national healthcare service by revising the 2002 National Health Security Act is not responsive to the needs of ethnic minorities, especially women and children.
As such, many risk experiencing worsening quality of life, especially in terms of universal health promotion and prevention. This much is clear from the Fifth Wave of the Unicef Multiple Indicator Cluster Survey (MICS5) on women and children's health, administered in cooperation with the Thai National Statistical Office (NSO) in 2015-2016.
The survey collected data on health, together with the development and protection of children and women, in over 28,000 households in Thailand's four regions and Bangkok, in 2015-2016. Thanks to universal health care, the report highlights the country's progress for children and women, especially in birth registration (99%) and access to clean drinking water and sanitation (98%). Officially, according to the Human Development Index (HDI), Thailand now supposedly enjoys "high" human development, ranking 87th in the world.
However, the report also illustrates how children and young people living in rural areas, children from poor households, and children whose parents have low levels of education, are falling behind in health, education, and overall development. "Children in rural areas and in poor families are facing the toughest journey growing up. It should not be this way. Every child deserves a fair chance in life," notes Thomas Davin, Unicef representative for Thailand. Moreover, in the HDI, Thailand is a distant fourth in Asean after Singapore (5th), Brunei (30th) and Malaysia (59th).
In particular, 7% of Thai children under five years old are moderately or severely underweight and 11% are too short. The rate is significantly higher among children whose mothers have had no education, at 17%. Male children, children living in the South, and children in the poorest homes are more likely to be malnourished.
Violence against children is also rife. For instance, three quarters of children aged 1–14 years experienced psychological or physical punishment by a member of their household. The majority experienced psychological aggression, such as shouting, yelling or screaming at them, including being called offensive names, or some type of physical punishment. Children in the North (81%) and Northeast (79%) are more likely to receive violent discipline, with violent parents more likely in poorer and poorly educated households. Research shows even mild forms of physical discipline are harmful to children, causing low self-esteem, emotional distress and depression.
Another very serious issue is salt iodisation, the lack of which contributes to low IQ levels, impacting levels by up to 15 points. The lowest salt iodisation is in the Northeast, where the Thai Lao ethnic community suffers from the second-lowest IQ of the major Thai ethnic communities, after the Thai Malays, where low salt iodisation, the language barrier, and the lack of integration may be affecting test scores. This indicates a dire need for more effective salt-iodisation mechanisms.
The official level of Thai literacy is 94%, based on primary-level literacy, that is, being able to read and write a short, simple statement about everyday life. Access to books is crucial for child stimulation and development. However, only 41% of children under the age of five live in households with at least three children's books. The rate drops to only 23% in the poorest households, compared with 73% in the richest households.
The lowest number of books found is in the Northeast, then the North, mirroring very low scores in Ordinary National Educational Test (Onet) results in the Thai Lao and especially Northern Khmer populations.
Also, crucially, Thai fathers play almost no role in their children's upraising, leaving the task almost exclusively to mothers. Only one-third of fathers regularly engaged in activities that promoted learning and school readiness. The rate is even lower among fathers from the poorest households (25%) compared with the richest households (52%).
Unfortunately, Thailand's failure to educate many mothers, especially those in poorer ethnic communities such as the Tibeto-Burman and Hmong-Mien minorities and the Thai Malay and Thai Lao, results in negative outcomes for children in terms of development, education and health. For example, 24% of children whose mothers have no education are out of school, compared with just 0.4% of children whose mothers have higher education. The rate is actually highest among children in households without Thai as a mother tongue (34%).
Thailand still has very young women giving birth. The birth rate for women aged 15-19 years is 51 births per 1,000 women. The North records the highest rate at 72. The birth rate is much higher among girls from poor households, standing at 82, and among girls with only primary education being 104 births. The rate for girls from the richest households is only 12, or just three for those from households with parents having higher education.
Urban migration for work, together with divorce, mean about 3 million children are living with neither parent although both are still alive. Instead, they may be placing considerable physical strain on the grandparents. The proportion is highest in the Northeast and among children from the poorest households.
"Thailand's progress for children in recent decades has been truly impressive. However, there exists a significant difference in the well-being of children depending on where they live, their ethnicity, their household income and their mother's education level. Inequality must be seriously addressed now. And we believe that Thailand can do this," Mr Davin said.
The report recommends investing in integrated early childhood development services, together with civil society and the private sector, to improve the first 1,000 days of each child's life, focusing on nutrition, mental and physical stimulation, early learning including access to books, and protection from violence.
While Thailand's universal healthcare is clearly beneficial, the proposed revisions to the act, including downgrading regional representation, together with adverse effects on civil society and community-based health organisations, will intensify inequality by location, background, and ethnicity.
The regime's centralisation paradigm will lessen accountability in public health decision-making, which will worsen the lives of marginalised groups. A holistic, representative, and democratic healthcare system must be kept intact.
John Draper is director, Social Survey Centre, College of Local Administration (COLA), Khon Kaen University. Peerasit Kamnuansilpa is a founder and former dean of the College of Local Administration, Khon Kaen University.